Woman who sweats blood from face and hands

Sweating blood from her face and the palms of her hands, a 21-year-old woman was admitted to an Italian hospital. Drs. Roberto Maglie and Marzia Caproni, both dermatologists at the University of Florence, reported the case Monday in the Canadian Medical Association Journal.

The patient, whose identity remains anonymous as is customary in case studies, had no signs of scratches or wounds. Her spontaneous bleeding episodes had no obvious trigger and each instance lasted anywhere from one to five minutes and then ended on its own.

Sometimes the bleeding occurred while the young woman was sleeping, at other times, while she was exercising or physically active. The patient had endured the condition for three years.

Embarrassed by the ghoulishness of her symptoms, the young woman had socially isolated herself and experienced symptoms of major depression, as well as panic disorder.

Analysis of her skin where the bleeding had occurred showed nothing unusual. Tests of her blood revealed no coagulation issues or other problems.

According to the journal, Maglie and Caproni diagnosed hematohidrosis, a rare disease marked by spontaneous discharge of “blood sweat” through intact skin.

The doctors first treated her depression and panic symptoms with an antidepressant, paroxetine, and an anti-anxiety medication, clonazepam. Next, they prescribed propranolol, a beta blocker prescribed to patients with heart conditions, a drug which had been used in similar cases in the past. This treatment reduced her bleeding, but did not end it.

“I believe the case is real,” said Dr. Jacalyn Duffin, a retired hematologist, and a medical historian and professor at Queen’s University in Ontario.Though Duffin did not treat or write about the patient, she explored the history of sweating blood cases and this particular case in an editorial published this week in the same journal.

Reading about “lots of cases all around the world,” Duffin said they shared surprising similarities in the way they occurred and how they happened. “The more research I did historically, the more I realized these people didn’t know each other and so they couldn’t be inspired by each other,” said Duffin. These individual cases, then, could not be attributed to copycat behavior.

In the accounts she read, the most common sites for sweating blood were the forehead, scalp, face, eyes and ears. “Some of them have had it on their trunk, some on their limbs — it appears it can be anywhere,” said Duffin.

Pain or tingling preceded some instances of sweating blood, while several patients experienced headaches or hypertension. Sweating blood is not exclusive to females, but most patients were women.

“Although it’s horrible to look at and horrible to suffer, it seems not to be associated with negative [health] outcomes,” said Duffin, adding that none of the patients reported in modern times had died of it.

Most patients, like the Italian woman, experience distress. A couple of the patients Duffin read about were infants. “I’m not sure that the infants experienced distress, but certainly their parents do,” she said.

“It’s terribly embarrassing and when nobody seems to know what causes it, it’s very frightening to have it,” said Duffin. “Doctors are perplexed and yet it’s so obvious and scary looking.”

The medical confusion is not for a lack of trying to understand this condition and its cause.

Multiple causes?

“In all the cases that were published, the blood was tested and there was no coagulation problem — including in the case today,” said Duffin. “Because the first thing you think is, ‘Oh, they’re a bleeder, they have a bleeding disorder.’ There was nothing wrong with their blood, so that implies there’s something wrong with their skin.”

There, too, the evidence was inconclusive. In some cases, blood appears in the sweat ducts, yet the ducts of other patients remain clean of blood. Skin biopsies appear normal.

While theories abound, none have been proven, said Duffin.

It could be that this phenomenon of having blood appear on your face could have multiple different causes,” she said, having speculated herself on the condition’s physiological origins.

In some cases, she noted, patients have experienced a terrible fright before the bleeding starts. “Suddenly your adrenaline goes up and if your adrenaline goes up, maybe it does something to the microvasculature your tiny capillaries in your skin that causes them to shrink or explode,” suggested Duffin. This unproven scenario could be one cause of bleeding skin.

“Or perhaps it’s an inherited fragility of the blood vessels in the skin,” said Duffin. “Or maybe it’s triggered by some chemical we don’t know about.”

“What we learned from the cases I reviewed in the literature, it can spontaneously remit in other words it can just vanish with no explanation,” said Duffin. “It comes with no explanation and it goes with no explanation.”